We are continuing development of this novel catheter technique, which establishes circumferential tension around the mitral valve annulus by exploiting both natural (coronary venous) and un-natural (intramyocardial septal) trajectories. We have established proof-of-principal in a porcine model of ischemic cardiomyopathy that cerclage annuloplasty reduces secondary (functional) mitral valve regurgitation. We have developed new catheter designs to simplify the procedure. We are attempting to reduce the demands on image guidance for the procedure. We have obtained institutional approval for a public SBIR solicitation to partner with small private companies to develop and refine catheter tools for cerclage, to be tested in patients in the future at the NIH Clinical Center. We have conceived a wholly new approach to treat tricuspid valve regurgitation.